Preoperative Comorbidity Correlates Inversely with Survival after Intestinal and Multivisceral Transplantation in Adults

We investigated the relationship between preoperative comorbidity and postoperative survival after intestinal transplantation. Each patient received a score for preoperative comorbidity. Each comorbidity was given a score based on the degree it impaired function (score range 0–3). A total score was derived from the summation of individual comorbidity scores. Patients (72 adults (M？:？F, 33？:？39)) received an isolated intestinal graft (27) or a cluster graft (45). Mean (standard deviation) survival was 1501 (1444) days. The Kaplan-Meier analysis revealed a significant inverse association between survival and comorbidity score (logrank test for trend, ). Patients grouped into comorbidity scores of 0 and 1, 2 and 3, 4 and 5, 6, and above had hazard ratios (95% confidence intervals) for death (compared to group 0 + 1), which increased with comorbidity scores: 1.945 (0.7622–5.816), 5.075 (3.314–36.17), and 13.77 (463.3–120100), respectively, ( ). Receiver-operator curves at 1, 3, 5, and 10 years postoperative had “C” statistics of 0.88, 0.85, 0.88, and 0.92, respectively. When evaluating patients for transplantation, the degree of comorbidity should be considered as a major factor influencing postoperative survival. 1. Introduction Over the last decade, intestinal transplantation has become an established treatment modality in the management of intestinal failure. The preoperative status of patients has been found to influence the outcome of surgery [1], and scores developed to semiquantify this [2, 3] have been used in routine practice to facilitate preoperative risk assessment. There has been considerable improvement in postoperative survival over the last 20 years. Much of this improvement has arisen from advances in immunosuppressive regimes and better preoperative preparation and postoperative care of patients [4]. Although survival after transplantation remains inferior to that on parenteral nutrition (PN), the gap is closing, and as a consequence patients are being considered for transplantation at an earlier stage. Potential improvement in quality of life is also now being factored in to the decision regarding a patient’s suitability for transplantation. It has therefore become very important to accurately assess patient’s individual survival chance. In our routine clinical practice, we have considered preoperative comorbidity to have a negative influence on postoperative survival [3]. We have semiquantified comorbidity for each patient and compared this to postoperative survival to determine the relationship. 2. Methods Preoperative comorbidity was